Selective intestinal cleansing reduces acquired candidemia in mechanically ventilated ICU patients.

The research paper explores the epidemiology and prevention of ICU-acquired candidemia (ICAC) among intensive care unit (ICU) patients, specifically focusing on the impact of Selective Digestive Decontamination (SDD) on the rate of ICAC. The study, conducted using the REA-REZO network, included adult patients receiving mechanical ventilation for at least 48 hours. A total of 94,437 patients were included, with 3,001 treated with SDD and 651 developing ICAC. The study found that the rate of ICAC was lower in patients receiving SDD, both in the matched cohort analysis and the overall population.

Factors Contributing to Candidemia and the Need for Prevention

Candida colonization from the gastrointestinal tract is identified as a key step towards severe infection, with factors such as immunosuppression, intestinal epithelial integrity loss, and gastrointestinal colonization contributing to the promotion of Candida bloodstream infection. The study also discusses the impact of ICU-acquired infections and the need for close monitoring and prevention due to the growing incidences of antifungal resistance and the emergence of Candida species of concern.

Association Between SDD and Rate of ICAC Among ICU Patients

The authors also assessed the association between SDD and the rate of ICAC among mechanically ventilated ICU patients and found a significant reduction in the rate of ICAC among those receiving SDD. Furthermore, the study reported a lower incidence of ICU-acquired multi-drug resistant (MDR) bacteria in SDD patients compared to those receiving standard care.

Challenges in Observational Studies and Future Research Needs

Despite the lower rate of ICAC in the SDD group, the study did not observe any significant difference in ICU length of stay, duration of mechanical ventilation, or mortality rates between the SDD and standard care groups. The study also highlighted the challenges in designing randomized clinical trials for low-incidence diseases and the need for additional research to explore the long-term effects of SDD on patients’ outcomes.

The study concludes that in a population with low prevalence of ICAC, SDD was associated with a lower rate of ICAC. However, this reduction in ICAC did not translate to higher survival. Additionally, the study acknowledges some limitations, including the potential for residual confounding factors due to the observational nature of the study and the need for further investigation into the long-term effects of SDD.

Reference –

Reizine, F., Massart, N., Joussellin, V. et al. Association between selective digestive decontamination and decreased rate of acquired candidemia in mechanically ventilated ICU patients: a multicenter nationwide study. Crit Care 27, 494 (2023). https://doi.org/10.1186/s13054-023-04775-1